CLASSIFICATION OF

DENTAL CARIES

Dr. Seeratulurooj
BDS MSc LUMHS
(Primary prevention)
Prevent, Arrest, Reverse

(Secondary prevention)
Deep scaling Restoration

Periodontal surgery Endodontics

Exodontics

)Tertiary prevention(
Prosthodontics orthodontics
 1.BASED ON ANATOMICAL SITE

OCCLUSAL
(PIT AND FISSURE)
SMOOTH SUR-
FACE CARIES
(PROXIMAL
AND CERVICAL
CARIES)

ROOT CARIES
 A- PIT AND FISSURE CARIES
 Highest prevalence of all caries bacteria rapidly colonize
the pits and fissures of the newly erupted teeth.
 These early colonizers form a “bacterial plug” that re-
mains in the site for long time, perhaps even the life of
the tooth
 Type & nature of the organisms prevalent in the oral cav-
ity determine the type of organisms colonizing the pit &
fissure
 The appearance of s.mutans in pits and fis-
sures is usually followed by caries 6 to 24
months later.
 Sealing of pits and fissures just after tooth
eruption may be the most important event in
their resistance to caries.
 Shape, morphological variation and depth of
pit and fissures contributes to their high sus-
ceptibility to caries.
-enamel in the bottom of pit or fissure is very thin, so early
dentin involvement frequently occurs.
here the caries follows the direction of the enamel rods.
-Caries is triangular in shape with the apex facing the sur-
face of tooth and the base towards the DEJ.
-when reaches DEJ, greater number of dentinal tubules are
involved.
- it produces greater cavitation than the smooth surface
caries and there is more undermining of enamel.
 B- Smooth surface caries
 Less favorable site for plaque attachment, usually at-
taches on the smooth surface that are near the gingiva or
are under proximal contact..
 In very young patients the gingival papilla completely
fills the interproximal space under a proximal contact
 The earliest manifestation of incipient caries (early caries) of
enamel is usually seen beneath dental plaque as areas of decalci-
fication (white spots).
 The proximal surfaces are particularly sus-
ceptible to caries due to extra shelter pro-
vided to resident plaque owing to the proxi-
mal contact area immediately occlusal to
plaque.
 Lesion have a broad area of origin and a
conical, or pointed extension towards DEJ.
 V shape with apex directed towards DEJ.
 After caries penetrate the DEJ softening of
dentin spread rapidly and pulpally
 C- ROOT SURFACE CARIES
 The proximal root surface, particularly near the cervical
line, often is unaffected by the action of hygiene proce-
dures, such as flossing, because it may have concave
anatomic surface contours (fluting) and occasional rough-
ness at the termination of the enamel.
 These conditions, when coupled with exposure to the oral
environment (as a result of gingival recession), favor the
formation of mature, caries-producing plaque and proximal
root-surface caries.
 Caries originating on the root is alarming because
1. it has a comparatively rapid progression
2. it is closer to the pulp
3. it is more difficult to restore
 The root surface is softer than the enamel and read-
ily allows plaque formation in the absence of good
oral hygiene.
 The cementum covering the root surface is ex-
tremely thin and provides little resistance to caries
attack.
 Root caries lesions progress more rapidly because of
the lack of protection from and enamel covering.
 2.BASED ON PROGRESSION

ACUTE CARIES ARRESTED CARIES

CHRONIC CARIES
 A- ACUTE CARIES
 Active caries lesion: a progressive carious lesion.
 Acute caries is a rapid process involving a large number
of teeth.
 These lesions are lighter colored than the other types, be-
ing light brown or grey.
 Pulp exposures and sensitive teeth are often observed in
patients with acute caries.
 It has been suggested that saliva does not easily penetrate
the small opening to the carious lesion, so there are little
opportunity for buffering or neutralizaton
 B- CHRONIC CARIES
 These lesions are usually of long-standing involve-
ment, affect a fewer number of teeth, and are smaller
than acute caries.
 Pain is not a common feature because of protection
afforded to the pulp by secondary dentin
 The decalcified dentin is dark brown.
 Pulp prognosis is hopeful in that the deepest of le-
sions usually requires only prophylactic capping and
protective bases.
 C- ARRESTED CARIES:-
Arrested (inactive) carious lesion: A lesion that may have
formed years previously and then stopped further pro-
gression.
 Caries which becomes stationary or static and does not
show any tendency for further progression
 Both deciduous and permanent affected
 With the shift in the oral conditions, even advanced le-
sions may become arrested .
 Arrested caries involving dentin shows a marked brown
pigmentation
 Sclerosis of dentinal tubules and secondary dentin forma-
tion commonly occur
 3.Based on virginity of lesion

INITIAL/PRIMARY RECURRENT/SECONDARY
 A- PRIMARY CARIES(INITIAL)
 lesions on unrestored tooth surface.
 A primary caries is one in which the lesion
constitutes the initial attack on the tooth sur-
face.
 The designation of primary is based on the ini-
tial location of the lesion on the surface rather
than the extent of damage.
 B- SECONDARY CARIES
(RECURRENT)
 This type of caries is observed around the edges and under
restorations.
 lesions that developed adjacent to a filling.
 The common locations of secondary caries are the rough
or overhanging margin and fracture place in all locations
of the mouth.
 It may be result of poor adaptation of a restoration, which
allows for a marginal leakage, or it may be due to inade-
quate extension of the restoration.
 In addition caries may remain if there has not been com-
plete excavation of the original lesion, which later may
appear as a residual or recurrent caries.
 4.Based on tissue involvement

1. Initial caries
2. Superficial caries
3. Moderate caries
4. Deep caries
5. Deep complicated caries
Dental caries can be divided into 4 or 5 stages

 Initial caries: Demineralization without struc-

tural defect. This stage can be reversed by fluo-
ridation and enhanced mouth hygiene
 Superficial caries (caries superficialis):Enamel
caries. Caries has affected the enamel layer, but
has not yet penetrated the dentin.
3. Moderate caries (Caries media): Dentin caries. Ex-
tensive structural defect. Caries has penetrated up to
the dentin and spreads two-dimensionally beneath the
enamel defect where the dentin offers little resistance.
4. Deep caries (Caries profunda): Deep structural defect.
Caries has penetrated up to the dentin layers of the
tooth close to the pulp.
5. Deep complicated caries (Caries profunda
complicata) :Caries has led to the opening of the pulp
cavity (open pulp).
5. BASED ON NUMBER OF TOOTH
SURFACE INVOLVED

Simple A caries involving only one tooth

surface
A caries involving two surfaces
Compound of tooth

Complex A caries that involves more than

two surfaces of a tooth
 6. BASED ON CHRONOLOGY

EARLY CHILDHOOD CARIES

ADULT CARIES

ADOLESCENT CARIES
the number of new lesions occurring in a year,
shows three peaks-at the ages 4-8, 11-19 and 55-
65 years
Rampant caries: is the name given to multiple ac-
tive carious lesions occurring in the same patient.
This frequently involves surfaces of teeth that do
not usually experience dental caries eg, bottle or
nursing caries, baby caries, radiation caries, or
drug-induced caries.
 EARLY CHILDHOOD CARIES
 Early childhood caries
would include, two vari-
ants: Nursing caries and
rampant caries.

 The difference primarily ex-

ist in involvement of the
teeth[ mandibular incisors ]
in the carious process in
rampant caries as opposed
to nursing caries.
 TEENAGE CARIES
(ADOLESCENT CARIES)
 This type of caries is a variant of rampant
caries where the teeth generally considered
immune to decay are involved.
 The caries is also described to be of a rapidly
burrowing type, with a small enamel opening.
 The presence of a large pulp chamber causing
early pulp involvement
 ADULT CARIES
 With the recession of the gin-
giva and sometimes decreased
salivary function due to atro-
phy, at the age of 55-60 years,
the third peak of caries is ob-
served.
 Root caries and cervical caries
are more commonly found in
this group.
 Sometime they are also asso-
ciated with a partial denture
clasp.
 7.BASED ON SURFACES TO BE
RESTORED
 Most widespread clinical utilization
O for occlusal surfaces
M for mesial surfaces
D for distal surfaces
F for facial surfaces
B for buccal surfaces
L for lingual surface
Various combinations are also possible, such as MOD –
for mesio-occluso-distal surfaces.
 8. BLACK’S CLASSIFICATION
Class 1 lesions:
 Lesions that begin in the structural defects of teeth such as
pits, fissures and defective grooves.
Locations include
 Occlusal surface of molars and premolars.
 occlusal two thirds of buccal and lingual surfaces of mo-
lars and premolars.
 Lingual surfaces of anterior tooth.

Class 2 lesions:
 They are found on the proximal surfaces of the bicuspids
and molars.
Class 3 lesions:
 Lesions found on the proximal surfaces of anterior teeth

that do not involve or necessitate the removal of the in-

cisal angle.
Class 4 lesions:
 Lesions found on the proximal surfaces of anterior teeth

that involve the incisal angle.

Class 5 lesions:
 Lesions that are found at the gingival third of the facial

and lingual surfaces of anterior and posterior teeth.

Class 6 (Simon’s modification):
 Lesions involving cuspal tips and incisal edges of teeth.
Diagnosis of dental caries
Diagnosis: is an art and science that results
from the synthesis of scientific knowledge, clinical
experience & common sense.
Caries diagnosis implies deciding whether a lesion is
active, progressing rapidly or slowly or whether is
already arrested.
Conventional diagnostic methods

By visually with the clinician’s eyes using direct

vision or vision assisted with a mirror and a
standard dental operatory light. In addition, a
small, rounded-end dental explorer or probe can
assist with the detection of small defects.
Use of explorer :
Explorer is useful to remove plaque and debris and
check the surface characteristics of suspected
carious lesions. gentle pressure just required to
blanch a fingernail without causing any pain or
damage, All surfaces of a tooth are cleaned of debris
and plaque, using an air syringe and examined
visually. Suspicious areas are explored to check for
the surface texture
Use of explorer is not advocated

because; Sharp tips physically damage small lesions

with intact surfaces, Probing can cause fracture &
cavitation of incipient lesion. It may spread the
organism in the mouth
Mechanical binding may be due to non-carious
reasons , Shape of fissure , Sharpness of explorer ,
Force of application , Path of explorer placement
All discolored areas should be explored using
gentle pressure. There is no need to penetrate a
suspected lesion with an explorer. If a discolored
and non-cavitated area is soft when explored, it is
recorded as non-cavitated carious pit or fissure . A
cavity is detected when there is an actual hole in the
tooth in which an explorer could easily enter the
space. An active cavity has soft walls or floors
RADIOGRAPHY
Carious lesions are detectable radiographically when there
has been enough demineralization to allow it to be
differentiate from normal. They are valuable in detecting
proximal caries which may go undetected during clinical
examination. On average they have around 50% to 70%
sensitivity in detecting carious lesions. 40% demineralization
is required for definitive decision on caries
bitewing radiography—either conventional or
digital. It has been shown that there is essentially
no difference between the diagnostic capabilities
of film and digital radiography when used for
bitewings.
Radiographic examinations include;
A- Bitewing radiographs
B- IOPA radiographs using paralleling technique
C- Dental panoramic tomograph

The two important decisions related to radiographic

examination are
(1) when to take a radiograph and
(2) how to evaluate a radiograph for presence of
signs of dental caries
Pitfalls Of Radiography
* 2 dimensional view of 3 dimensional object
* Radiographic depth of a lesion is often less than
actual depth
*Overlapping of proximal surfaces on a radiograph
*Occlusal (incipient) caries of enamel difficult to
detect
* Dental anomalies like hypoplastic pits mimic
proximal caries
Types of system
Direct digital radiography

A sensor placed into the

mouth of patient and ex-
posed to x-rays ,the sensor
captures the radiographic
image and then transmits
the image to a monitor of
Indirect digital radiography

Is the scanning
method, the existing
x-ray film digitizes
and then displays it
on the computer
monitor.
 Advantages
1-Less radiation exposure
2-Images can be manipulated
3-Storage and archiving of patient information
4-Patient education & interaction
5-Instant image display
6-Eliminates film and processing expenses
 Disadvantages

1-Expensive

2-Sensor size

3-Infection control

4-Image resolution less than conventional film

Intraoral camera
Intra-oral cameras are an
important part of
dentistry chair units con-
tribute to enhance im-
proving patient care dur-
ing the treatments
Types ofWireless
IOC Camera

The wireless camera may be

powered by a battery or a
cable.

Wired camera
The wired camera can be
connected to the computer
using USB cable
FIBEROPTIC TRANSILLUMINATION

Different index of light transmission for decayed & sound

tooth. Decayed tooth structure has decreased index &
appears dark. The tooth is illuminated using fiberoptics.
Have a high level intra & inter-examiner variability.
Digital imaging FOTI introduced, images captured by a
camera & fed into the computer for image analysis. DIFOTI
can detect caries on all types of teeth & also detect incipient
& recurrent caries before their visibility on radiographs
ELECTRIC MEASUREMENTS FOR CARIES
Tooth demineralization due to caries process causes
increased porosity of tooth structure. This porosity
contains fluid containing ions. This leads increased
electrical conductivity, conversely, leads to
decreased electrical resistance or impedance
Factors affecting electrical measurements
* Porosity
* Surface area
* Thickness of the tissues
* Hydration of enamel
* Temperature
* Concentrations of ions in the dental tissue fluids
Diagnodent
is a laser-based instrument which uses
fluorescent properties of the carious lesion
to produce a quantitative reading of in-
fected carious tissue, particularly dentine
caries. Diagnodent should be used with
care. it can produce false positives due to
stain or dental materials.